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CHART NO. � <br /> everett I <br /> � _ '� �ncTlNf_ I -l( -�i� <br /> City of Everett - `�"�Q" � � �� <br /> � <br /> c _ ,. .. - ; c� � <br /> i ' .. <br /> Sewer Application and P_er�iit: ; <br /> - - yx�: �� `" _ <br /> - - �.� � <br /> ;; __ = :. _ =�;, : - <br /> _''s _. _ - - <br /> NO. Z S fi S 7 DATE u:��n �� io9z <br /> Scrvice Address Aa9 - �otto pr se Ulility Accaunt No. <br /> Billing Address $� <br /> City.State,Zip �^^QYS,—wn �n_ion _ permit Fee $ 30.00 <br /> Owner _�� ��--��. Connection Charge <br /> Connectionby �„�,a� Tmnk $—�7g;.gr� <br /> Address - Lateral $ <br /> Total Connection Charge $ �vn-p� <br /> Phone U�ility Development Fee <br /> Legal Description: Water $ _2z4.00 I <br /> Lot �n Sewer $—�q,n(� <br /> Block Total Development Fee $ �13.Oo <br /> plat �b�..ts s�� viev niv. i7 <br /> Unplatted Description: Sewer Bond Districl _p�d ;i <br /> AbuVing Lm Line <br /> N,S,E,W �t. <br /> Type o�Permi[ im: .+vn.+�nv . _ Approved By <br /> Remarks Issued By��i�— <br /> Customer Signawre <br /> IMPORTANT! <br /> CALL 1•800-424-5555 48-HOURS <br /> PRIOR TO DIGGING ����� <br /> CALL 259-8810 FOR INSPECTION Inspec�ion By ����(����'� <br /> Date Inspected �//��- <br /> SEESKETCHATTACHED No. ZHsr'J7 <br /> INSPECTION <br />